Coronavirus Update #23
MEMA Resource Requests, DEA Waiver, Essential Staff, and More
MEMA - Request for Resources

Centers are now able to make resource requests directly to the Maryland Emergency Management Agency (MEMA). Please see the instructions here.

All requests for resources will now be sent to request.mema@maryland.gov

The MEMA Resource Section will input the information contained in these emails into a WebEOC request (on the requestor's behalf), and task that request to the appropriate fulfilling body. MEMA will have a staffer solely dedicated to monitoring the email account and gathering any necessary data from the requester.  
DEA Allows Delivery of Medication-Assisted Treatment Drugs to Quarantined Patients

A waiver granted by the Drug Enforcement Administration (DEA) may provide a solution for long term care providers with opioid-addicted residents who are unable to access medication-assisted treatment (MAT) due to coronavirus-induced quarantine.

The waiver allows DEA-registered narcotic treatment programs (NTPs) to provide take-home medications to quarantined patients through alternative delivery methods under the NTP's established chain of custody protocol. Specifically, NTPs are permitted to make a "doorstep" delivery of take-home medications in an approved lockbox. 

Making Decisions on Essential Staff Entering Your Building 

When deciding if a person needs to enter your building (including employees or outside contractors such as therapy , pharmacy, lab, portable x-ray, mental health provider, repair technicians, and others), all long term care facilities should consider the intent of the federal and state guidance on visitation and building entry restrictions.

The intent is to restrict entry of as many people as possible to reduce the risk of COVID-19 entering and/or spreading in the building. Anybody entering the building must comply with the most current federal and state COVID-19 guidelines. Entering multiple buildings during the day should be discouraged, or increased attention to infection control processes should be applied in cases when it is essential.
  
This decision needs to be balanced with meeting the needs of the resident. The risk-benefit trade off needs to be made on a case-by-case basis and should be informed by the high mortality associated with contracting this virus in the elderly. This decision process should also be evaluated and adjusted as necessary as the COVID-19 situation evolves in your local community and building.
Reminder: SNF Bed Capacity Inventory Survey

  • As we advised post-acute providers last week, Maryland post-acute providers can accept hard to place non-Covid-19 hospital transfers now in order to help free-up acute care in hospitals for COVID-19 patients.

  • Hard to place patients include those who have high drug costs that are paid for in hospitals, but not in SNFs. We will continue to work with AHCA/NCAL, with our Congressional Delegation, and with the Hogan team for CMS regulatory and financial relief on this front.

  • No decisions yet. But in advance of the acute care surge associated with COVID-19, it is important that we inventory SNF capacity to take non-COVID-19 med/surg patients to free-up acute care space. 

  • For the future, plan now: we strongly urge SNFs to begin now creating separate wings, units, or floors by moving current residents to handle future full surge admissions from the hospitals and keep current residents separate, if possible.

Please complete this SNF bed capacity survey ASAP. Note that this survey should be completed once per center ; please make sure the appropriate person on your team completes the survey.
Reminder: HFAM & Hospital Partner Call - Today at 4:00 PM

Along with the Maryland Hospital Association (MHA), the University of Maryland Medical System (UMMS), Johns Hopkins Medicine, LifeBridge, and other hospital partners, HFAM will be hosting our second call to connect our sectors. HFAM will invite broadly and work with partners and other associations to make all post-acute providers aware of this call.

The purpose of that call will be to discuss topics of mutual interest such as transfers between hospitals and post-acute facilities, telehealth, and any other priorities amid the COVID-19 pandemic.

This call will take place Monday, March 23 at 4:00 PM EST
 
Dial-in: +1-415-655-0001
Passcode: 316 561 900 #
Update from Governor Hogan

Today, Governor Hogan announced additional measures to slow the spread of COVID-19, including the closure of all non-essential businesses.

Health care, including s enior living facilities, including independent living, assisted living, and skilled
nursing are all considered essential.

Click here for additional guidance from the Office of Legal Council.
Concentra Update

Please click this link for Concentra's FAQ and tools for how to deal with work related injuries during this time. Concentra is also in the process of expanding their Telemedicine and Telerehab services into all of thier centers. Please contact Dan Clark with any questions.

Providers are receiving vendor emails or other contact offering PPE supplies, and some may not be legitimate vendors or businesses. Please beware that some offers are scams and are not credible businesses. To help you spot the difference between legitimate businesses and scams, the Federal Trade Commission (FTC) has provided some general guidance on COVID-19-related scams. AHCA/NCAL has also compiled a list of helpful questions to ask yourself and the business in question.

In addition, the Social Security Administration (SSA) has released this fraud advisory alert warning the public about fraudulent letters threatening suspension of Social Security benefits due to COVID-19 or coronavirus-related office closures. The Social Security Administration will not suspend or discontinue benefits because their offices are closed.

With the restriction around non-essential visitors to skilled nursing centers and assisted living communities to minimize the risk of spread of COVID-19, there have been many questions on handling residents’ personal laundry, including for those who may have previously had their laundry done by a family member.  

AHCA/NCAL has developed some additional guidance   on this. You can also follow CDC guidelines for environmental infection control in healthcare facilities . CDC states that “Infection has not been linked to laundry procedures in residential-care facilities, even when consumer versions of detergents and laundry additives are used.”
Updates from the Centers for Medicare and Medicaid Services (CMS)


The Centers for Medicare and Medicaid Services (CMS) announced that they are delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.
This delayed release will eliminate the need for significant SNF MDS training during the upcoming months as well as avoid increased documentation nationwide. 
CMS staff continues to be actively engaged in discussions with AHCA and various other stakeholders, regarding the various changes, the impacts of these changes, as well as, the timeline to educate and train facility staff and update software and IT systems.
 

CMS has provided Medicare Advantage (MA) organizations with flexibilities. However, it is up to each individual MA plan to determine what flexibilities they will implement. It also applies to Medicare Medicaid Plans (MMPs). 

MA organizations have the ability to :

  1. Waive or reduce enrollee cost-sharing for beneficiaries impacted by the outbreak.
  2. Provide enrollees access to Medicare Part B services via telehealth in ANY geographic area and from a variety of places, including a beneficiaries’ home.
  3. Waive plan prior authorization requirements that otherwise would apply to tests or services related to COVID-19.
  4. Relax “refill too soon” edits and provided maximum extended day supply on drugs.
  5. Reimburse enrollees for prescriptions obtained from out of network pharmacies.
  6. Relax plan-imposed policies that may discourage certain methods of delivery such as mail or home delivery, for retail pharmacies that choose to offer these delivery services in these instances.
  7. Waive prior authorization requirements at any time that would otherwise apply to Part D drugs used to treat or prevent COVID-19 if or when such drugs are identified.

MA organizations are required to :
During disaster or emergency (declared by the Governor of a state or Protectorate) the following are in effect until the end date identified in the State declaration or for 30 days, if no end date is identified in the declaration. 

  1. Cover benefits furnished at non contracted facilities if the facilities have participation agreements with Medicare.
  2. Waive, in full, requirements for gatekeeper referrals where applicable.
  3. Provide the same cost sharing for the enrollee at a non-contracted facility as if it were a contracted facility.
  4. Changes that benefit the enrollee can be effective immediately without the 30-day notification requirement (examples include reductions in cost sharing and waiving prior authorizations). 
Did you miss HFAM's previous alerts?

Visit our website to view all previous HFAM alerts, as well as guidance
from our federal and state partners.
Please email COVID19@ahca.org for additional questions, and visit
www.ahcancal.org/coronavirus for additional information and resources.
Thank you.

We cannot thank you enough for the dedication and diligence in doing all that you can for the residents in your communities. HFAM continues to monitor the COVID-19 pandemic with our state and national partners and will do all we can to support you during this time.